TY - JOUR

T1 - High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality

AU - the VISION Cardiac Surgery Investigators

AU - Devereaux, P. J.

AU - Lamy, Andre

AU - Chan, Matthew T.V.

AU - Allard, René V.

AU - Lomivorotov, Vladimir V.

AU - Landoni, Giovanni

AU - Zheng, Hong

AU - Paparella, Domenico

AU - McGillion, Michael H.

AU - Belley-Côté, Emilie P.

AU - Parlow, Joel L.

AU - Underwood, Malcolm J.

AU - Wang, Chew Yin

AU - Dvirnik, Nazari

AU - Abubakirov, Marat

AU - Fominskiy, Evgeny

AU - Choi, Stephen

AU - Fremes, Stephen

AU - Monaco, Fabrizio

AU - Urrútia, Gerard

AU - Maestre, Marialuz

AU - Hajjar, Ludhmila A.

AU - Hillis, Graham S.

AU - Mills, Nicholas L.

AU - Margari, Vito

AU - Mills, Joseph D.

AU - Billing, J. Stephen

AU - Methangkool, Emily

AU - Polanczyk, Carisi A.

AU - Sant'Anna, Roberto

AU - Shukevich, Dmitry

AU - Conen, David

AU - Kavsak, Peter A.

AU - McQueen, Matthew J.

AU - Brady, Katheryn

AU - Spence, Jessica

AU - Le Manach, Yannick

AU - Mian, Rajibul

AU - Lee, Shun Fu

AU - Bangdiwala, Shrikant I.

AU - Hussain, Sara

AU - Borges, Flavia K.

AU - Pettit, Shirley

AU - Vincent, Jessica

AU - Guyatt, Gordon H.

AU - Yusuf, Salim

AU - Alpert, Joseph S.

AU - White, Harvey D.

AU - Whitlock, Richard P.

N1 - Funding Information: Supported by an operating grant from the Canadian Institutes of Health Research , the Canadian Institutes of Health Research Foundation , the Canadian Institutes of Health Research Strategy for Patient Oriented Research (through the Ontario SPOR Support Unit, and the Ontario Ministry of Health and Long-Term Care), and Abbott Laboratories (grants and in-kind donation of high-sensitivity cardiac troponin I assays used in this study); in Canada, grants from the Hamilton Health Sciences New Investigator Fund , the Canadian Network and Centre for Trials Internationally , the Hamilton Health Sciences Research Strategic Initiative , McMaster University Surgical Associates , the Academic Health Science Centres Alternative Funding Plan Innovation Fund Ontario, and the Population Health Research Institute Internal Funding Program ; in China, a grant from the General Research Fund 14101414, Research Grant Council, Hong Kong Special Administrative Region ; in Malaysia, a University of Malaya research grant (RG302-14AFR); in Australia, the National Heart Foundation of Australia Vanguard Grant (101034) and a grant from the National Health and Medical Research Program ; in the United Kingdom, the British Heart Foundation Personal Chair grant (CH/F/21/90010) and Research Excellence grant (RE/18/5/34216); and in Spain, a grant from the Instituto de Salud Carlos III (PI13/00502). Publisher Copyright: Copyright © 2022 Massachusetts Medical Society.

PY - 2022/3/3

Y1 - 2022/3/3

N2 - BACKGROUND Consensus recommendations regarding the threshold levels of cardiac troponin elevations for the definition of perioperative myocardial infarction and clinically important periprocedural myocardial injury in patients undergoing cardiac surgery range widely (from >10 times to ≥70 times the upper reference limit for the assay). Limited evidence is available to support these recommendations. METHODS We undertook an international prospective cohort study involving patients 18 years of age or older who underwent cardiac surgery. High-sensitivity cardiac troponin I measurements (upper reference limit, 26 ng per liter) were obtained 3 to 12 hours after surgery and on days 1, 2, and 3 after surgery. We performed Cox analyses using a regression spline that explored the relationship between peak troponin measurements and 30-day mortality, adjusting for scores on the European System for Cardiac Operative Risk Evaluation II (which estimates the risk of death after cardiac surgery on the basis of 18 variables, including age and sex). RESULTS Of 13,862 patients included in the study, 296 (2.1%) died within 30 days after surgery. Among patients who underwent isolated coronary-artery bypass grafting or aortic-valve replacement or repair, the threshold troponin level, measured within 1 day after surgery, that was associated with an adjusted hazard ratio of more than 1.00 for death within 30 days was 5670 ng per liter (95% confidence interval [CI], 1045 to 8260), a level 218 times the upper reference limit. Among patients who underwent other cardiac surgery, the corresponding threshold troponin level was 12,981 ng per liter (95% CI, 2673 to 16,591), a level 499 times the upper reference limit. CONCLUSIONS The levels of high-sensitivity troponin I after cardiac surgery that were associated with an increased risk of death within 30 days were substantially higher than levels currently recommended to define clinically important periprocedural myocardial injury.

AB - BACKGROUND Consensus recommendations regarding the threshold levels of cardiac troponin elevations for the definition of perioperative myocardial infarction and clinically important periprocedural myocardial injury in patients undergoing cardiac surgery range widely (from >10 times to ≥70 times the upper reference limit for the assay). Limited evidence is available to support these recommendations. METHODS We undertook an international prospective cohort study involving patients 18 years of age or older who underwent cardiac surgery. High-sensitivity cardiac troponin I measurements (upper reference limit, 26 ng per liter) were obtained 3 to 12 hours after surgery and on days 1, 2, and 3 after surgery. We performed Cox analyses using a regression spline that explored the relationship between peak troponin measurements and 30-day mortality, adjusting for scores on the European System for Cardiac Operative Risk Evaluation II (which estimates the risk of death after cardiac surgery on the basis of 18 variables, including age and sex). RESULTS Of 13,862 patients included in the study, 296 (2.1%) died within 30 days after surgery. Among patients who underwent isolated coronary-artery bypass grafting or aortic-valve replacement or repair, the threshold troponin level, measured within 1 day after surgery, that was associated with an adjusted hazard ratio of more than 1.00 for death within 30 days was 5670 ng per liter (95% confidence interval [CI], 1045 to 8260), a level 218 times the upper reference limit. Among patients who underwent other cardiac surgery, the corresponding threshold troponin level was 12,981 ng per liter (95% CI, 2673 to 16,591), a level 499 times the upper reference limit. CONCLUSIONS The levels of high-sensitivity troponin I after cardiac surgery that were associated with an increased risk of death within 30 days were substantially higher than levels currently recommended to define clinically important periprocedural myocardial injury.

KW - Aged

KW - Aortic Valve/surgery

KW - Biomarkers/blood

KW - Cardiac Surgical Procedures/adverse effects

KW - Coronary Artery Bypass/adverse effects

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Myocardial Infarction/blood

KW - Postoperative Complications/blood

KW - Prospective Studies

KW - Reference Values

KW - Troponin I/blood

UR - http://www.scopus.com/inward/record.url?scp=85126116030&partnerID=8YFLogxK

UR - https://www.mendeley.com/catalogue/12bd2e36-cf3e-367d-b0fd-e28cd22a8e76/

U2 - 10.1056/NEJMoa2000803

DO - 10.1056/NEJMoa2000803

M3 - Article

C2 - 35235725

AN - SCOPUS:85126116030

VL - 386

SP - 827

EP - 836

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 9

ER -